Management on the Mend, John Toussaint, MD Book Club Study Questions. 1. Could Tish s story happen in our hospital? Why or why not?

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1 Management on the Mend, John Toussaint, MD Book Club Study Questions Introduction 1. Could Tish s story happen in our hospital? Why or why not? 2. Dr. Toussaint makes a bold claim, that there is a lean model for transformation that works. What are the components of the model introduced in this section? 3. What do you think about his assessment that robust organizations need lean facilitators to comprise 1% of the FTE workforce? How might we achieve greater lean facilitator infrastructure in our organization? Chapter One - Laying the Foundation 1. In this opening chapter, what is the pre-work for mending management? Why does he state that it is necessary? 2. Who needs to change? 3. What is the way to quickly unify the senior executive team? 4. Patient stories of gaps, safety/harm events can be powerful levers for change in an organization. What caution does Dr. Toussaint offer about this strategy? 5. What stories in our organization could be powerful to ignite passion and spur change for the better? 6. Who are some of the big voices in our organization who need to be engaged in the development of model cells? How might these big voices participate in improvement work? 2016 Catalysis - Developed by: Bronson Healthcare 1

2 Chapter Two - The Model Cell 1. What message are you sending the organization with your model cell? 2. What are the five guidelines Dr. Toussaint recommends for developing the model-cell concept? 3. What roles will the model cell play in an organization? 4. What insights did you gain from reading the case example of Lehigh Valley s ED model cell? 5. What tools and principles does Dr. Toussaint state are especially useful in model cell work? 6. Dr. Toussaint recommends building an enterprise-wide value stream map of the patient experience early. Discuss in your group the rationale for and arguments against this idea. What would be the pros and cons of doing this in conjunction with a model cell? 7. Dr. Toussaint shares recommended standard work for planning and learning within a model cell. What are they? 8. Discuss where our organization is in developing these model cell standards. Chapter Three - Values and Principles 1. What is the difference between values and principles? 2. Dr. Toussaint recommends embracing the Shingo principles. Please choose one of the principles described in the chapter and be prepared to talk about an area at our hospital where we exhibit this principle well, and where we don t really live by that principle Catalysis - Developed by: Bronson Healthcare 2

3 Chapter Four - The Central Improvement Team 1. In Dr. Toussaint s opinion, what are the three main purposes of the Central Improvement Team? 2. Dr. Toussaint recommends incorporating organizational improvement efforts into Central Improvement. What barriers would our hospital face in doing this? 3. What are the two ways Dr. Toussaint describes how to develop Central Improvement teams? Chapter Five The Daily Management System 1. Dr. Toussaint talks about a daily management system with standard work at varying levels. What are these different levels? What are some ways our organization could improve the Standard Work on each of these levels? 2. How good is the upward-flowing path of information at our organization and how can this be improved? 3. ThedaCare has fewer than three strategic initiatives each year. How does this compare to our hospital? How are our current initiatives impacting the 20/80 rules discussed in the chapter? 4. Where do I begin? A question heard repeatedly. Dr. Toussaint gives the answer begin where you need it most, with the tools that seem most likely to be useful. Where does our organization need it most and what are next steps for us? 2016 Catalysis- Developed by: Bronson Healthcare 3

4 Chapter Six - Spreading the Work 1. What are some steps Dr. Toussaint recommends to overcome the apparent contradiction of needing to spread improvement but that it would never work simply by picking it up and plopping it down? 2. What do you think about both of the alternatives he proposes to spread (Beta Sites and Modular instruction of the core components)? Which one do you think would work best at our hospital? 3. In this chapter, Dr. Toussaint mentions that lean facilitators found it s best to grab the most willing participants first. Has your experience aligned with that? 4. What do you think the three main pillars mean (Standardization, Customization and Fingerprints)? Chapter Seven - Developing People 1. What was the big change at ThedaCare that Dr. Toussaint refers to at the beginning of chapter? How does this compare to our current situation? 2. In an effort to improve the customer experience at ThedaCare they used focus groups to identify four main values for their team members. What were they? Is it a good list? 3. According to Dr. Toussaint, what is the first and most important promise an organization must make when starting lean implementation? Why is it important to make it a HR statement? 4. Later in the chapter he asks the question What makes a person become more interested in his or her work? What causes people to disengage and become careless? Discuss these questions Catalysis- Developed by: Bronson Healthcare 4

5 Chapter Eight - Lean Finance 1. What reasoning does Dr. Toussaint provide to support eliminating annual budgets? 2. What benefits may be realized with the adoption of a forecasting system, as Dr. Toussaint suggests? 3. Dr. Toussaint outlines five methodical steps he would take to move from budgeting to forecasting. Discuss the outlined steps. If our hospital were to adopt a forecasting system, what would be our first steps? Chapter 9 - Clinical Business Intelligence (CBI) 1. What is the order of sets which are needed as we consider the flow of information in a lean transformation? 2. What was the stated goal for the creation of the CBI system? 3. For the Decision Resources team at ThedaCare, how did they get their work? How did that evolve? 4. Early on, ThedaCare got their data from finance. What did they discover were the pros and cons of that data? 5. Map out the steps involved to develop a CBI system. What surprised you and what did you learn in these steps? 6. Dr. Toussaint states CBI is about collaboration with operations to drive improvement. Reflect and respond to how our hospital currently delivers on the statement, Information Technology collaborates with operations to drive improvement. 7. What is the value of an IT maturity tool? 2016 Catalysis - Developed by: Bronson Healthcare 5

6 Chapter 10 - Barriers to the Work 1. What are the three barriers Dr. Toussaint states are outside of an individual organization? 2. What risks does an organization take by remaining a fee for service payment model? 3. What quality and data reporting experiments does Dr. Toussaint describe in this chapter? 4. What further data reporting is needed for patients to have the information that they need to make healthcare decisions? Chapter 11 - Taking the First Step 1. In this chapter, he summarizes the components of the book. What additional insights or ah-ha thoughts did you have while reading this synthesis? For more information visit ManagementontheMend.org Visit us at createvalue.org (920) info@createvalue.org 2016 Catalysis- Developed by: Bronson Healthcare 6